What does it take to drive big health care system change? Trump’s HHS head, Alex Azar, recognizes that commercial health plans do not have the power. Only Medicare and Medicaid can lead the way. Jessie Hellman reports for The Hill that Azar’s goal is to get insurers and providers to provide consumers health care cost information before getting care.
The inability or lack of desire of commercial insurers to drive down hospital costs has made care increasingly unaffordable for Americans. Moreover, unlike Medicare, commercial insurers have refused to make their hospital or doctor rates transparent, keeping Americans in the dark about the the cost of their care.
Azar says that patients have a right to know what a procedure will cost in advance of receiving it. Of course, they do. Yet, it generally is not in the providers’ or insurers’ interests to disclose this information, or they would do so. There is ample evidence of consumer need and strong public pressure.
Powerful health care stakeholders put their financial interests ahead of consumer interests, because they can. It is hard to see how a few minutes of strong admonishments from Secretary Azar will make any difference, except perhaps from a public relations perspective. We need government regulations, which Azar says he supports if hospitals and insurers do not voluntarily disclose price information.
Azar also wants to do away with fee-for-service medicine and pay for “value.” He does not define what he means by value or how it would work. And, since the devil is in the details and no one has yet figured out how to pay for value for most services, that is concerning. But, Azar does recognize that when it comes to system reform, “Only Medicare and Medicaid have the heft, the market concentration, to drive this kind of change, to be a first mover.”
Improved Medicare for all is the best way to rein in costs and understand whether we are paying for value. Improved Medicare for all would provide everyone full coverage, without coinsurance and deductibles. It has the leverage to ensure provider rates are fair. Simply giving people price information is not nearly enough to bring down provider rates. People are usually not in a position to shop for their care, so knowing the price matters little. Moreover, rarely do we buy services based on price alone; quality matters as well.
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